Educational class inequalities in the incidence of coronary heart disease in Europe

Veronesi, Giovanni; Ferrario, Marco; Kuulasmaa, Kari; Bobák, Martin; Chambless, Lloyd E.; Salomaa, Veikko; Söderberg, Stefan; Pająk, Andrzej; Jørgensen, Torben; Amouyel, Philippe; Arveiler, Dominique; Drygas, Wojciech; Ferrières, Jean; Giampaoli, Simona; Kee, Frank; Iacoviello, Licia; Malyutina, Sofia; Peters, Annette; Tamošiūnas, Abdonas; Tunstall‐Pedoe, Hugh; Cesana, Giancarlo

doi:10.1136/heartjnl-2015-308909

Cited by 64 publications

(58 citation statements)

References 38 publications

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“…For example, smoking was identified as the major mediator of CHD inequalities among European men, but not for women from Central/South and East Europe where less educated women were less likely to smoke. In this study, HDLC was identified as the main driver of the socioeconomic inequalities in CHD observed for European women 35. Similar sex differences in the socioeconomic patterning of CVD risk factors have been identified in other studies 36.…”

Section: Discussionsupporting

confidence: 86%

Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Backholer

Peters

Bots

et al. 2016

J Epidemiol Community Health

162

111

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Section: Discussionsupporting

confidence: 86%

Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Backholer

Peters

Bots

et al. 2016

J Epidemiol Community Health

162

111

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“…44 If this is the case, and the excluded cases from lower socioeconomic groups were to have even more adverse risk factor profiles, then we may have underestimated inequalities in our study. However, our findings accord well with broader international comparisons which have adopted similar methods for studying trends in absolute and relative inequality in CVD incidence 45 but it should be noted that a substantial proportion of the educational differentials in incidence is not explained by trends in risk factors (or indeed case fatality).…”

Section: Strengths and Limitationssupporting

confidence: 87%

Cardiovascular risk factors—using repeated cross-sectional surveys to assess time trends in socioeconomic inequalities in neighbouring countries

et al. 2017

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ObjectivesThis study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI).DesignRepeated cross-sectional studies.SettingPopulation based.Participants3500–4000 in national surveys in NI and 5000–9000 in RoI, aged 20–69 years.MeasuresEducational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries.ResultsIn both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002).ConclusionsInterventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries.

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“…Inequalities in the distribution of risk factors have already been documented in these populations17; a summary by geographic regions is reported in online supplementary table III in supplementary file. Most of RIIs were reduced after adjustment for smoking, alcohol intake, BMI, non-HDL and HDL-cholesterol, systolic blood pressure and diabetes, with the notable exception of Central and South European populations (table 3, last three columns on the right).…”

Section: Resultsmentioning

confidence: 99%

Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies

Veronesi

Kee

Chambless

et al. 2017

J Epidemiol Community Health

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BackgroundKnowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.Materials and methodsThe MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.ResultsCompared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86–413 and 78–156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%–130% and 40%–89% of the average incidence rates. Inequalities in risk factors accounted for 45%–70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.ConclusionsSocial inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

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Educational class inequalities in the incidence of coronary heart disease in Europe

Abstract: Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.

Cited by 64 publications

References 38 publications

Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Cardiovascular risk factors—using repeated cross-sectional surveys to assess time trends in socioeconomic inequalities in neighbouring countries

Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies

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